The Comparison of Dose Related Efficacy and Side Effects of Intrathecal Sufentanil in Labor Analgesia / 대한마취과학회지

BACKGROUND: There are quite a few studies examining the relative efficacy of different doses of intrathecal sufentanil for labor analgesia. The authors designed this prospective, randomized, double blind study to compare the efficacy and side effects of 5 and 10 microgram intrathecal sufentanil. METHODS: Forty healthy, laboring, term parturients, in the active phase of labor participated in this study. In a randomized, double-blind fashion, patients received 5 or 10 microgram intrathecal sufentanil as a part of combined spinal-epidural technique. Scores of pain, itching, nausea, and sedation were taken on visual analog scales before and every 10 minutes after drug injection for one hour. We also recorded maternal blood pressure, respiratory rate and peripheral oxygen saturation during the same time period. RESULTS: Both doses of sufentanil provided adequate analgesia. Although 10 microgram sufentanil produced a slightly more profound analgesia, the duration of pain relief did not differ between the two groups. Both drug doses were associated with significant increase in itching. The 10 microgram dose was associated with more sedation and a greater decrease in arterial oxygen saturation (SaO2). CONCLUSIONS: Both 5 and 10 microgram intrathecal sufentanil provided adequate labor analgesia. Both doses were associated with increased spinal (itching) and supraspinal (sedation, respiratory depression) side effects, the intensity of which appeared to be more profound in the 10 microgram group.

The Comparison of Dose Related Efficacy and Side Effects of Intrathecal Sufentanil in Labor Analgesia / 대한마취과학회지

BACKGROUND: There are quite a few studies examining the relative efficacy of different doses of intrathecal sufentanil for labor analgesia. The authors designed this prospective, randomized, double blind study to compare the efficacy and side effects of 5 and 10 microgram intrathecal sufentanil. METHODS: Forty healthy, laboring, term parturients, in the active phase of labor participated in this study. In a randomized, double-blind fashion, patients received 5 or 10 microgram intrathecal sufentanil as a part of combined spinal-epidural technique. Scores of pain, itching, nausea, and sedation were taken on visual analog scales before and every 10 minutes after drug injection for one hour. We also recorded maternal blood pressure, respiratory rate and peripheral oxygen saturation during the same time period. RESULTS: Both doses of sufentanil provided adequate analgesia. Although 10 microgram sufentanil produced a slightly more profound analgesia, the duration of pain relief did not differ between the two groups. Both drug doses were associated with significant increase in itching. The 10 microgram dose was associated with more sedation and a greater decrease in arterial oxygen saturation (SaO2). CONCLUSIONS: Both 5 and 10 microgram intrathecal sufentanil provided adequate labor analgesia. Both doses were associated with increased spinal (itching) and supraspinal (sedation, respiratory depression) side effects, the intensity of which appeared to be more profound in the 10 microgram group.

The Analysis of Emergency Medical Transport by EMS Helicopter

BACKGROUND: The fast EMS helicopter was introduced to Korea in 1996 and from Dec. 1. 1997, it was used far transporting emergent patients. Authors, here upon, report the transporting experiences. METHODS: From Dec. 1, 1996 to Dec. 31,1997, Samsung Medical Centers EMS helicopter was used for air evacuation of critically ill patients. The patients data prospectively analyzed. RESULT: A total of 65 patients were transported. Male to female ratio was 1.95 : 1. The mean transport time was 64.1min(10-160 min). Majority of the evacuated patients was surgical patients (General Surgery'16, Orthopedic surgery : 10, Neurosurgery : 6, Infernal medicine 13, Pediatrics : 3, and others : 3). Twenty-one of the 65 patients transported were admitted to ICU and 31 did not require ICU care. During the air evacuation, one physician and one nurse trained for air evacuation amended The patients. No medical problems or deaths developed during the air evacuation period. CONCLUSION: The first EMS helicopter was introduced to Korea in 1996. From Dec. 1, 1996 to Dec. 31, 1997, Samsung Medical Center's EMS helicopter was used for air evacuation of critically ill patients. The patients data reported.

The Effects of Stomach Cancer Surgery on Immunomodulation and Neuroendocrine Response: Comparison of Anesthesia and Analgesia Methods / 대한마취과학회지

BACKGROUND: Authors have undertaken this study to see if the choice of anesthesia can directly or indirectly provide immunomodulation for cytokines, to determine the relationship of cytokines and hypothalamo-pituitary-adrenal axis in stomach cancer surgery patients, and also to see whether the amount of morphine administration and choice of analgesia can influence cytokine release, and possibly immunity. METHODS: Total 19 gastric cancer surgery patients were randomly assigned in double-blind fashion into two groups. Group-G (n=9) was provided with general anesthesia plus morphine intravenous patient controlled analgesia (IV-PCA), whereas group-GE (n=10) with preemptive epidural and general anesthesia plus continuous epidural analgesia for control of postoperative pain. At predetermined time interval, proinflammatory cytokines and stress hormones were evaluated with visual analog pain scale. Simultaneous assessments of operating and anesthesia time, total morphine doses, the time to recovery of gastrointestinal function and incidences of complications were also made. RESULTS: Demographic data, the durations of operation and anesthesia and recovery of gastrointestinal function were similar in both groups. Total morphine doses were approximately four times greater in group-G. Secretions of interleukin-1 beta , TNF and epinephrine were blocked by preemptive epidural anesthesia, meanwhile, interleukin-6 as well as ACTH and cortisol were not. After 24 hours after skin incision, the differences of cytokines, ACTH and cortisol between two groups were dissipated. In spite of these hormonal findings, visual analog pain scale could not disclose any differences. Incidences of complications were statistically insignificant except that of itching in group-GE. CONCLUSION: Preemptive epidural anesthesia and analgesia can partially block only some of cytokines and stress hormones, and these effects do not have clinically relevant long term influences. The amounts and means of morphine administered by continuous epidural analgesia block or IV-PCA demonstrated no evidence of immunosuppression at clinical dose range.

Dexamethasone Treatment of Bone Pain in Metastatic Prostate Cancer: Assessment of Pain Indices and Quality of Life / 대한마취과학회지

BACKGROUND: Steroid therapy has been considered as co-analgesic for palliative treatment of metastatic bone pain in terminal cancer. We designed prospective study to observe analgesic efficacy of dexamethasone, to evaluate different analgesic assessment methods and its correlation to actual improvement of quality of life. METHODS: Thirty seven men with symptomatic bone pain of prostate cancer were treated with dexamethasone infusions (10mg twice a day) for 2 weeks. Response to treatment was assessed by daily analgesic intake, by the McGill-Melzack pain questionnaire (MPQ), and by a series of 17 linear analog self-assessment scales (LASA) relating to pain and to various aspects of quality of life. Biochemical and radiological markers were measured. RESULTS: Fourteen patients (38%) had improvement in indices used to assess pain at 2 weeks after starting dexamethasone. Reduction in pain indices was associated with improvement in other dimensions of quality of life and in the scale for overall well-being. Even though radiological and biochemical markers showed no correlation, symptomatic relief of pain was associated with a decrease in serum concentration of adrenal androgens. CONCLUSION:g We conclude that 1) dexamethasone treatment may cause useful relief of pain in some of patients with bone pain of prostate cancer; 2) this relief of pain is associated with suppression of adrenal androgens; 3) measures of pain and quality of life can be used to assess benefits of systemic therapy with dexamethasone; and 4) this effects of dexamethasone should be further investigated in bone pain of other metastatic cancer.

The Radiological Measurement of Cervical Spine Extension during Bullard or Direct Laryngoscopy / 대한마취과학회지

Background: Conventional laryngoscopy with Macintosh blade requires a movement of the head, neck and cervical spine. The Bullard laryngoscope is an anatomically shaped, potentially eliminating the need for cervical spine extension. Bullard and Macintosh laryngoscopes were compared by measuring the degree of cervical spine extension by radiological measurement. Methods: Eighteen patients requiring endotracheal intubation were studied. Anesthesia was induced in neutral head position followed by laryngoscopy. Each patients was intubated two times by Macintosh and Bullard laryngoscope in random order. Radiographic evaluation was performed to determine the degree of cervical spine extension on four occasions; before induction, during facial mask ventilation, and during Bullard and Macintosh laryngoscopy. Results: The extension of cervical spine was significantly less following Bullard laryngoscopy than Macintosh laryngoscopy for best view (p<0.05). Conclusions: The Bullard laryngoscope can be used with less cervical spine extension than Macintosh laryngoscope. It may be useful in patients in whom cervical spine movement is limited or undesirable.

Protective Effect of Hypothermia in Delayed Astrocyte Death after Transient Histotoxic Hypoxia in Vitro / 대한마취과학회지

BACKGROUND: It is well known that neuronal degeneration can occur after a brief deprivation of energy source. To investigate whether glial astrocyte can induce a phenomenon of delayed cell death after transient energy loss and to see how different are the effects of nifedipine, lidocaine, carnosine and hypothermia on delayed toxicity in astrocyte. METHODS: Human astrocytoma cells (U1242MG) were used in this study. To assess the astrocyte survival during post-ischemic period after transient histotoxic hypoxia, 3-[4,5-dimethylthiazol-2yl]-2,5, diphenyl tetrazolium bromide (MTT) test was used. Compared to MTT test, tryphan blue test was also used to demonstrate membrane damage of affected cells. Studies on intracellular calcium dynamics during ischemic and post-ischemic period were carried out with fluo-3 and flow cytometry system. RESULTS: The percentage survival of astrocyte during post-ischemic period was decreasing with time. Calcium channel blocker nifedipine, sodium and calcium channel blocker lidocaine and free radical scavenger carnosine could not prevent post-ischemic cell damage. But, hypothermia was only an effective method in ameliorating post-ischemic cell death. Intracellular calcium increase during ischemia and post-ischemia was dependent on extracellular calcium influx. CONCLUSIONS: Only hypothermia was effective in reducing astrocyte death during post-ischemia after transient energy depletion. Intracellular calcium alterations during post-ischemia was from extracellular space.

Pulmonary Function Changes during Spinal Anesthesia - Bupivacaine vs. Tetracaine - / 대한마취과학회지

BACKGROUND: Although degree of motor blockade during high thoracic spinal anesthesia is difficult to determine, pulmonary function may reflect the level of motor blockade. So we checked pulmonary function during spinal anesthesia with two different local anesthetic agents. METHODS: 50 patients, ASA PS 1-2, were randomly divided into two groups. After basal pulmonary function test (FVC: forced vital capacity, FEV1: forced expiratory volume in one second, PEFR: peak expiratory flow rate, PEP: peak expiratory pressure, PIP: peak inspiratory pressure.), the patients received spinal anesthesia with either 0.5% hyperbaric bupivacaine or 0.5% hyperbaric tetracaine. Thirty minutes after injection, level of sensory blockade was checked by pinprick test and pulmonary function test was performed. RESULTS: Almost all the values of pulmonary function reduced after spinal anesthesia, but the degrees of reduction were not differ in two groups except PEP, which reduced more profoundly in tetracaine group than bupivacaine group. CONCLUSIONS: It is more desirable that we use bupivacaine rather than tetracaine as spinal anesthetic agent in the patient with poor pulmonary function.

Subcutaneous Emphysema and Pneumomediastinum during Laparoscopic Burch Operation / 대한마취과학회지

Laparoscopic Burch operation is one of laparoscopic surgery for stress urinary incontinence. Subcutaneous emphysema and hypercarbia are potential complications of laparoscopic surgery, but are more likely to occur in extraperitoneal surgery than in intraperitoneal surgery, since insufflated CO2 can diffuse easily into the surrounding tissues. We report a patient in whom pneumomediastinum and extensive subcutaneous emphysema developed during laparoscopic Burch operation. Transient hypoxemia was also accompanied with hypercarbia. Possible mechanisms are presented, along with discussion of prompt diagnosis and treatment. For the management of laparoscopic extraperitoneal surgery, it is necessary to be careful with monitoring of CO2 insufflation pressure, routine examination and palpation of chest wall, use of N2O with caution, increase of ventilation to eliminate CO2, and excluding other causes of subcutaneous emphysema and hypercarbia.

Coagulation Status Changes during Progressive Hemodilution / 대한마취과학회지

BACKGROUND: Hemodilution reduces the concentration of clotting factors in blood and this may induce some degree of impairment of coagulation. But there are some evidence that hemodilution may induce a hypercoagulable state. The goal of this study is to investigate the changes of coagulation status during progressive hemodilution. METHODS: Whole Blood was diluted by 10% increment to 80% with 0.9% normal saline. At each 10% dilution blood coagulation status was analysed using thrombelastography (TEG) and was compared with that of an undiluted control specimen obtained concurrently from the same patients. RESULTS: Hemodilutions up to 40% decrease r and K times and increase values of MA and angle. Hemodilutions more than 70% increase r and K times and decrease values of MA and angle. CONCLUSIONS: Hemodilutions up to 40% increase coagulability and hemodilutions more than 70% decrease coagulability of whole blood in vitro.

A Study about the Bronchial Cuff Volume of the Left-sided Double-Lumen Endobronehial Tube / 대한마취과학회지

"Background: In using the Double-lumen tube (DLT), knowing the minimum bronchial cuff volume (MCV) for an effective air-tight seal will be useful; to provide a collapse of the lung; and to avoid pressure damage. The aims of the present study are thus three-fold: to measure the MCV; to measure the diameter of left main bronchus (LMBD); and to prove any relationships between two parameters. METHODS: One hundred men and forty women who needed intubation of left-sided DLT were enrolled in this study. 37 Fr DLTs were used in male patients, and 35 Fr DLTs were used in female patients. We evaluated the MCV by air bubble method and measured the LMBD in chest PA. We also evaluated the pressure/volume characteristics of the bronchial cuffs by control inflator. RESULTS: 29 patients of 100 patients (29%) exhibited persistent air leakage in 2.5 ml cuff volume in male patients (group of MCV >2.5). On the contrary, 18 patients of 40 patients (45%) did not require any cuff volume in female patients (group of MCV 0). The mean LMBD were 13.23 1.45 mm in male and 11.09 0.96 mm in female. There were significant positive correlations between MCV and LMBD in both sex and their respective correlation coefficients were 0.264 (P=0.008) in male and 0.484 (P=0.002) in female. The equations of linear regression were: LMBD = 12.394 0.429xMCV in male, LMBD = 10.725 0.438xMCV in female. CONCLUSIONS: The MCV of the brochial cuffs in left-sided DLTs has significant relationships with the LMBD measured in chest PA.

Effect of Lidocaine on Intracellular Calcium Alterations during Energy Depletion and Reperfusion in Glial Cells / 대한마취과학회지

No abstract available.

Comparison of Butorphanol and Morphine Patient Controlled Analgesia after Gynecological Surgery / 대한마취과학회지

BACKGROUND: Intravenous patient controlled analgesia (IV-PCA) is a very popular and relatively safe technique due to its innate negative feedback mechanism. Morphine, the most commonly used analgesic, however, has its own drawbacks due to troublesome side effects. Narcotic agonist-antagonists are known to have ceiling effects not only to their analgesic potency, but also to their side effects. The authors studied the efficacy and incidence of side effects of Butorphanol IV-PCA for postoperative analgesia and compared these to morphine. METHODS: 38 ASA class I or II patients, undergoing gynecological surgery were randomly assigned into two groups, respectively Butorphanol and Morphine and examined hemodynamic changes, overall pain relief, patients satisfaction and the frequency of side effects. After general anesthesia, each patient randomly received loading dose of butorphanol or morphine in the recovery room and discharged to the floor with the PCA module. Upon arrival, individual patient was evaluated at predetermined time interval for 24 hours. RESULTS: The percentage of patient satisfaction was very high in both groups. The incidence of nausea was less in butorphanol group. The incidence of other side effects was statistically insignificant. CONCLUSIONS: Butorphanol has less incidence of side effects and comparable level of analgesia when compared to morphine. We conclude that butorphanol may be considered as a part of routine IV-PCA regimen, in postoperative pain management.

Reperfusion Injury in Glial Cells: The Phenomenon and Mechanism of "Calcium Paradox" / 대한마취과학회지

BACKGROUND: Mechanisms of secondary injury(post-ischemic injury) in the central nervous system have recently reported in a vast of amount of experiments. Among many factors which give rise to post-ischemic neuronal damage, glial deterioration probably mediated by calcium paradox, could be another of the aggravating deleterious factors to the already ischemic neurophil. METHODS: here we have designed experiment to investigate calcium paradox in astroglial cell line, human astrocytoma U1242MG. Intracellular calcium alterations in experimental cells were monitored by using calcium indicating dye fura-2 and epifluorescent photometry system. RESULTS: Intracellular free calcium changes during reperfusion phase after exposure to low calcium led to a prompt increase in intracelluar calcium level after 10 and 30 minutes. The way of calcium entry during the reperfusion phase was mediated by the reverse mode of NA+/Ca2+ exchanger. Cells that had a reduction of reperfusate calcium to 10uM increased cell viability. Also we observed an inverse relationship between major enzymatic activity in the astrocytoma cells(i.e., gultamine synthetase activity) and the duration of reperfusion in the the same protocols. CONCLUSIONS: A relatively small amount of intracellular clcium increase by the reverse mode of Na+/Ca2+ exchanger during the reperfusion period is related to a limitation of enzyme activity and viability 24hours later.